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High Rate of Obstetric Problems in HIV+ Ottawa Women With Free Care
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Third International Workshop on HIV and Women, January 14-15, 2013, Toronto
Mark Mascolini
Despite access to free care, HIV-positive women in Ottawa, Canada had a high prevalence of adverse obstetric outcomes in a 20-year chart review [1]. Not having a partner, psychiatric illness, and hepatitis C virus (HCV) infection more than quadrupled the odds of adverse outcomes in this study of 145 pregnancies.
Adverse obstetric outcomes have long been a concern in HIV-positive women, even among those living in countries with free access to care. Yet correlates of adverse outcomes remain poorly understood. To assess prevalence and risk factors of adverse obstetric outcomes in pregnant women with access to comprehensive medical care, Ottawa researchers conducted this 20-year chart review.
The study involved all pregnant HIV-positive women treated at the Ottawa Hospital from 1990 through 2010. The investigators extracted data from patient charts, focusing on three obstetric outcomes: low birth weight (less than 2500 g), preterm delivery (less than 37 weeks), and small for gestational age (birth weight less than 10th percentile). Chart review also provided individual patient data, HIV treatment-related variables, medical history, and socioeconomic traits. The researchers used postal code at the time of delivery as a surrogate for income.
Over the 20-year study period, 87 women averaging 30.7 years in age had 145 pregnancies resulting in 123 live births (85% of 145). Thirteen deliveries involved emergency cesarean section, 49 were planned C-sections, 51 were vaginal deliveries, and 11 delivery types were unrecorded. Thus 62 of 113 deliveries with a known type (55%) were C-sections, compared with 26% in Canada's general population.
Of 123 live births, at least one adverse obstetric outcome occurred in 24 (19.5%). Those adverse outcomes included 17 preterm deliveries, 11 infants small for gestational age, and 9 infants with low birth weight. Nine deliveries resulted in more than one adverse outcome. Adding 4 stillbirths yielded a total of 28 adverse obstetric outcomes. The stillbirth rate of 2.7% more than quadrupled the 0.6% rate in the general population.
Univariate analysis identified four factors associated with adverse obstetric outcomes analyzed as a composite measure of the three focus outcomes:
-- No live-in partner: OR 4.0 (95% confidence interval [CI] 1.39 to 12.5), P = 0.011
-- Psychiatric history: OR 5.13 (95% CI 1.68 to 15.7), P = 0.004
-- Hepatitis C infection: OR 7.63 (95% CI 1.68 to 34.7), P = 0.009
-- Among African/Caribbean immigrants, each additional year in Canada: OR 1.21 (95% CI 1.05 to 1.39), P = 0.01
No other variable was significantly associated with obstetric outcomes, including lack of antiretroviral therapy, detectable viral load, or income based on postal code, which was uniformly low in this study group.
The researchers concluded that adverse obstetric outcomes were higher than expected compared with the general population in Canada.
Reference
1. Buchan S, Spaans J, Sabri E, et al. Prevalence and predictors of adverse obstetrical outcomes in women with HIV: a twenty year chart review. Third International Workshop on HIV and Women, January 14-15, 2013, Toronto. Abstract O_14.
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